Provider Demographics
NPI:1194258319
Name:BEVERLY, KRISTEN (NP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037
Mailing Address - Country:US
Mailing Address - Phone:334-782-7757
Mailing Address - Fax:334-383-9918
Practice Address - Street 1:300 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037
Practice Address - Country:US
Practice Address - Phone:334-382-2681
Practice Address - Fax:334-383-9918
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily